炎症指标在结缔组织病相关间质性肺病并发呼吸衰竭中的预测价值

Predictive Value of Inflammatory Markers in Connective Tissue Disease-associated Interstitial Lung Diseases with Respiratory Failure

目的探讨炎症指标在结缔组织病相关间质性肺病(connective tissue disease-associated interstitial lung diseases,CTD-ILDs)并发呼吸衰竭(respiratory failure,RF)中的预测价值。方法回顾性分析2017-01/2023-05月在作者医院就诊的200例CTD-ILDs患者基础资料、氧分压(oxygen partial pressure,PaO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、白细胞计数(white blood cell,WBC)、淋巴细胞计数(lymphocyte,LYM)、单核细胞计数(monocyte,MONO)、中性粒细胞计数(neutrophil,NEUT)、血小板计数(platelet,PLT)、血红蛋白(hemoglobin,Hb)、血清白蛋白(albumin,ALB)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT);计算两组患者的中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板/淋巴细胞比率(platelet-to-lymphocyte ratio,PLR)、淋巴细胞与单核细胞比值(lymphocyte to monocyte ratio,LMR)、系统免疫炎症指数(systemic immune inflammatory index,SII)、预后营养指数(prognostic nutritional index,PNI)、系统免疫炎症营养指数(systematic immune inflammation nutritional index,SIINI)水平。根据入院时PaO_(2)结果将患者分为RF组和非RF组。比较两组患者的基础资料,将各炎症指标与PaO_(2)水平进行Spearman相关性分析;并将炎症指标对CTD-ILDs患者并发RF进行多因素Logistic回归分析;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析炎症指标对CTD-ILDs患者并发RF的预测价值。结果RF组患者的病程、年龄、WBC、MONO、NEUT、CRP、PCT、NLR、SII、SIINI水平均明显高于非RF组(P均<0.05),PaO_(2)、LYM、LMR、PNI明显低于非RF组(P均<0.05)。PaO_(2)与NLR、SII、SIINI呈负相关,与LMR、PNI呈正相关;NLR与SII、SIINI呈正相关,与LMR、PNI呈负相关;SII与SIINI呈正相关,与LMR呈负相关;SIINI与LMR、PNI呈负相关;LMR与PNI呈正相关(P均<0.05)。NLR升高是CTD-ILDs并发RF的独立危险因素和预测因素,NLR预测CTD-ILDs并发RF的曲线下面积(area under the curve,AUC)为0.765,SII、SIINI预测CTD-ILDs并发RF的AUC分别为0.684、0.683,三者联合检测的AUC为0.783。结论NLR升高是CTD-ILDs患者并发RF的独立危险因素。NLR、SII、SIINI三者联合对CTD-ILDs患者并发RF的预测能力优于任一单项指标。

Objective To discuss the predictive value of inflammatory markers in connective tissue disease-associated interstitial lung diseases(CTD-ILDs)with respiratory failure(RF).Methods The basic data,oxygen partial pressure(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),white blood cell(WBC),lymphocyte(LYM),monocyte(MONO),neutrophil(NEUT),platelet(PLT),hemoglobin(Hb),albumin(ALB),erythrocyte sedimentation rate(ESR),C reactive protein(CRP),procalcitonin(PCT)of 200 patients with CTD-ILDs admitted to author′s hospital from January 2017 to May 2023 were retrospectively analyzed;the levels of neutrophil to lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),systemic immune inflammatory index(SII),prognostic nutritional index(PNI)and systematic immune inflammation nutritional index(SIINI)of the two groups were calculated.According to the results of PaO_(2)at admission,the patients were divided into RF group and non-RF group.The basic data of the two groups were compared,and the Spearman correlation analysis was per-formed between the inflammatory indicators and PaO_(2)levels;the risk factors of RF in CTD-ILDs patients were analyzed by multivariate Logistic regression analysis;the predictive value of inflammatory markers for CTD-ILDs complicated with RF patients was analyzed by receiver operating characteristic(ROC)curve.Results The course of disease,age,WBC,MONO,NEUT,CRP,PCT,NLR,SII and SIINI levels in the RF group were obviously higher than those in non-RF group(all P<0.05),while the PaO_(2),LYM,LMR and PNI were obviously lower than those in non-RF group(all P<0.05).The PaO_(2)was negatively correlated with NLR,SII,SIINI,but positively correlated with LMR and PNI;NLR was positively correlated with SII,SIINI,but negatively correlated with LMR and PNI;SII was positively correlated with SIINI,but negatively correlated'with LMR;SIINI was negatively correlated with LMR and PNI;LMR was positively correlated with PNI(all P<0.05).Elevated NLR was independent risk factor and predictive factor of CTD-ILDs complicated with RF,the area under the curve(AUC)of NLR predicting CTD-ILDs complicated with RF was 0.765,the AUC of SII and SIINI predicting CTD-ILDs complicated with RF were 0.684 and0.683 respectively,while the combining AUC of the three was 0.783.Conclusion Elevated NLR is an independent risk factor for CTD-ILDs patients complicated with RF.The combination of NLR,SII and SIINI is better than any single indicator in predicting CTD-ILDs patients complicated with RF.